7 Invokana Side Effects You Should Know About

Invokana (canagliflozin) is a prescription medication that’s FDA-approved to treat Type 2 diabetes alongside exercise and a healthy diet. It’s also approved to lower the risk of heart attack, stroke, and new or worsening kidney problems in people with Type 2 diabetes. It belongs to a group of medications called sodium glucose co-transporter 2 (SGLT2) inhibitors.

Like all medications, Invokana can cause side effects. Some are mild and treatable, while others are more serious (but rare). Below, we’ll discuss seven Invokana side effects and tips on how to manage them.

1. Genital infections

The most common Invokana side effect is yeast infections. They’re more commonly reported by women, but they can also occur in males.

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Symptoms of a vaginal yeast infection include:

• Itching

• Discharge that’s thicker and whiter than usual vaginal discharge

• A general pain or burning sensation in the vagina

• Pain with urination or sex

• Soreness or redness in the vaginal area

Symptoms of a yeast infection in males may also include itchiness, redness, and irritation. You may also see abnormal discharge that looks similar to cottage cheese.

While yeast infections are uncomfortable, they can usually be treated quickly.

After checking with your healthcare provider, they may recommend an over-the-counter (OTC) or prescription medication. OTC options like Monistat (miconazole) can treat yeast infections in women. It comes in various forms that are inserted into the vagina. And clotrimazole is an OTC option for female and male yeast infections.

A common prescription option for female and male yeast infections is fluconazole (Diflucan). This typically only needs to be taken one time as a single pill.

To lower your chances of getting a yeast infection, wear underwear with a cotton crotch and avoid wearing tight fitting clothes. You should also change tampons or pads often and change out of sweaty workout clothes or wet swimsuits as soon as possible.

Other common conditions like bacterial vaginosis (BV) can present with similar symptoms to yeast infections. But these conditions aren’t treated in the same way, so it’s important to talk to your healthcare provider if you have any signs of a genital infection.

Rarely, Invokana can cause a serious bacterial infection called Fournier’s gangrene in the genital area. If you experience pain and swelling in the genital and anal areas, an abnormal smell in this area, or a fever, talk to your provider right away.

2. Urinary tract infections

Urinary tract infections (UTIs) are a common Invokana side effect. Common UTI symptoms include:

• Pain or burning when you pee

• Feeling that you need to pee urgently

• Peeing more often (which can be a side effect of Invokana itself)

• Pain in the lower abdomen

• Cloudy or blood-tinged urine

Luckily, UTIs are treatable. But if left untreated, a UTI can progress to a more serious infection called pyelonephritis. So, make sure to get treatment as soon as you feel symptoms.

Usually, a short course of antibiotics is all you’ll need. But they can take a day or two to kick in. So, speak with your healthcare provider right away if you start to notice any signs or symptoms of a UTI.

In the meantime, you can ask them to recommend OTC medications to provide relief while you wait for the antibiotics to work. These include pain relievers like acetaminophen (Tylenol) and ibuprofen (Motrin, Advil). It also includes phenazopyridine (AZO, Pyridium, Uricalm), a medication that helps numb the urinary tract to offer relief for UTI symptoms.

And to help avoid UTIs while you’re taking Invokana, there are some lifestyle changes you can try. For example, drinking 2 to 3 liters of water a day has been shown to lower the risk of UTIs in some people. And peeing after sex may also help lower your risk.

3. Low blood pressure

Invokana helps treat diabetes by allowing your body to get rid of excess sugar. It does this by helping you pee more. But in rare cases, this can lead to too much fluid loss and severely low blood pressure. This can hurt your kidneys and lead to hospitalization or death.

Symptoms of low blood pressure include dizziness, lightheadedness, and blurry vision. This rare Invokana side effect is more common in people who already have kidney problems. It’s also more common if you take certain diuretics called loop diuretics, or if you’re older.

So, make sure your healthcare provider knows your medical history and all the medications you take before starting Invokana.

4. Low blood sugar

When combined with insulin or some diabetes medications, Invokana can cause hypoglycemia (low blood sugar). Generally, hypoglycemia is defined as a blood sugar less than 70 mg/dL. It may cause symptoms like shakiness, a fast heartbeat, and sweating.

On its own, Invokana doesn’t usually cause hypoglycemia. But when it’s combined with certain other diabetes medications — like insulin, sulfonylureas, and meglitinides — hypoglycemia may occur. Your dose of these medications may need to be lowered while you take Invokana.

If you experience symptoms of hypoglycemia, treat it as soon as possible. Untreated hypoglycemia is a medical emergency.

Consuming 15 g of fast-acting sugar — like half a cup of soda or fruit juice — is a quick way to raise your blood sugar. It’s also a good idea to get into the habit of checking your blood sugar regularly if you don’t already.

5. Lower limb amputation

Invokana used to have a boxed warning for lower limb amputation (the necessary removal of a toe, foot, or other part of your leg). A boxed warning is the most serious risk the FDA can assign a medication. But, the FDA removed the warning in 2020 when new studies showed that the risk was lower than previously thought.

Still, if you have risk factors for amputation, like a diabetic foot ulcer, let your healthcare provider know before starting Invokana. Other risk factors include a prior amputation, problems with blood flow (peripheral vascular disease), and nerve problems (neuropathy).

To lower your risk of amputation, take care of your feet. This includes regular foot checks for any abnormal changes like foot sores.

6. Ketoacidosis

Invokana may cause a dangerous condition called diabetic ketoacidosis (DKA). Usually, DKA presents as very high blood sugar and acid levels in the blood.

The risk may be greater with higher doses of Invokana. And some people are also more likely to experience ketoacidosis, like people who severely limit their calorie intake or who have alcohol dependence.

It’s important to note that DKA from Invokana doesn’t always show up as very high blood sugar. Other symptoms of ketoacidosis may include thirstiness, vomiting, and shortness of breath.

If you start to develop symptoms, get emergency medical help. DKA is a medical emergency that needs treatment in a hospital.

7. Bone fractures

It’s possible that Invokana can make your bones weaker, leading to a greater risk of bone fractures (breaks). This may be because Invokana has been shown to lower estrogen levels, which is associated with weaker bones. Research has shown this may occur as early as 12 weeks after starting Invokana.

But a more recent 2022 study showed that Invokana wasn’t more likely to cause fractures than other diabetes medications like glucagon-like peptide-1 (GLP-1) agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors.

Still, if you have a history of fractures or osteoporosis, let your healthcare provider know. And if you have any risk factors for fractures — like smoking, excessive alcohol use, or chronic steroid use — let your provider know.

When should I contact my healthcare provider about Invokana side effects?

Let your healthcare provider know if you experience symptoms of any genital or urinary side effects, including itching or burning in the genital area, or a greater urge to pee.

If you experience severe pain or swelling in these areas, or a fever, talk to your provider right away. This may be a sign of a more serious infection.

If you experience any signs of the serious side effects discussed above — like severely low blood sugar or ketoacidosis — get emergency medical care.

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Written by:

Makaela Premont, PharmD

Makaela Premont, PharmD, is a pharmacist and the founder of uniquelymickie.com, a website dedicated to helping pharmacy students and pharmacists create a life that they enjoy. She received her Doctorate of Pharmacy from the University of South Carolina and is a licensed pharmacist in North Carolina.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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